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General NPI Number Information
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NPI Number | 1427647395
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Entity Type | Organization
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Legal Business Name | GRACE ACUPUNCTURE AND HERBAL MEDICINE, LLC
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Dates
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Enumeration Date | 01/14/2021
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 577 CHESTNUT RIDGE RD
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City | WOODCLIFF LAKE
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State | NJ
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Zip | 07677-8409
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Country | US
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Telephone | 201-292-4448
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Fax |
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Provider Business Mailing Address
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Address Line | 577 CHESTNUT RIDGE RD
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City | WOODCLIFF LAKE
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State | NJ
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Zip | 07677-8409
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Country | US
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Telephone | 201-292-4448
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Fax | 201-520-1313
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Authorized Official
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Title or Position | OWNER
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Name | DR. GRACE J KIM
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Credential | DACM
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Telephone | 201-292-4448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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